Overall Summary:

The 2013 Sexually Transmitted Disease (STD) Statistics include a summary of surveillance data for Minnesota’s reportable STDs: chlamydia, gonorrhea, syphilis, and chancroid. In Minnesota, STDs are the most commonly reported communicable diseases and account for nearly 70% of all notifiable diseases reported to the Minnesota Department of Health (MDH). In 2013 the number of reported bacterial STDs increased to 23,133 cases, representing an overall increase of 10% from the previous year. The change in incidence rates varied by disease, with chlamydia increasing by 4%, gonorrhea increasing by 26%, and primary/secondary syphilis increasing by 64%.

Sources of Data:

STD Case Reporting
Under state law (Minnesota
Rule 4605.7040), both physicians and laboratories must report laboratory-confirmed infections of chlamydia, gonorrhea, syphilis, and chancroid to the MDH within one working day. Other common sexually transmitted conditions such as herpes simplex virus (HSV) and human papillomavirus (HPV) are not reported to the MDH.

MDH Partner Services Program
All early syphilis cases, and many untreated chlamydia or gonorrhea cases reported to the MDH are referred to the Partner Services Program to ensure treatment of patients and their sexual partners. Additional surveillance data is collected through this process including information on sexual behavior and drug use.

Gonococcal Isolate Surveillance Project (GISP)
As part of the national Gonococcal Isolate Surveillance Project (GISP) funded by the Centers for Disease Control and Prevention (CDC), the MDH monitors antimicrobial susceptibilities of Neisseria gonorrhoeae. A Minneapolis STD clinic submits isolates on a monthly basis to the MDH. Sociodemographic and behavioral data for each case are also submitted. As of 2008, the MDH ceased routine susceptibility testing for GISP isolates, but still collaborates with the CDC to perform susceptibility testing.

Population counts used to calculate incidence rates by residence (i.e., state, counties, Minneapolis, and Saint Paul), by age, by gender, and by race/ethnicity were obtained from the U.S. Census Bureau. Incident rates (number of reported cases per 100,000 persons) were calculated using yearly case data and population counts from the decennial census. Population counts for 1991 to 1999 were estimated by interpolation between the 1990 and 2000 census data. Rates for 2013 were calculated using population counts from the 2010 Census, the most recent year for which counts by race, age, gender, and residence were available at the time of calculation and preparation. This 2013 data release includes rates calculated using population estimates for the calendar years between the 2000 and 2010 U.S. Censuses.

Chlamydia:

Chlamydia is the most commonly reported communicable disease in Minnesota. From an all-time low of 115 cases per 100,000 in 1996, the incidence of chlamydia has tripled to 353 per 100,000 in 2013. Over these years, increases were seen across all gender, age and geographical groups. The rates have quadrupled among men (54 to 220 per 100,000) and more than doubled among females (175 to 484 per 100,000). Among 30-39 year-olds, the incidence rate is over five times higher in 2013 compared to 1996. Rates have doubled among American Indians, Blacks, and Hispanics and almost tripled among Whites and Asian/Pacific Islanders. In addition to an increase of disease in the population, other factors may have contributed to the increases seen during these years including increased reporting by providers, use of improved STD diagnostic tools, improved screening practices by clinicians, counting only lab reports as cases and the addition of an active surveillance component to the MDH’s STD surveillance system.

In 2013, the chlamydia rate increased by 4% overall and remained highest among women (484 per 100,000), Blacks (1,517 per 100,000), and 20-24 year-olds (2,142 per 100,000). The rates increased by 7% among males and 3% among females. Adolescents (15-19 year-olds) and young adults (20-24 year-olds) have the highest rates and comprise the majority of cases, rates among males increased the most among those over 50+ years (35%), and rates among females increased the most among those 45-49 years (30%). Across geographic areas, the City of Minneapolis had the highest incidence rate (933 per 100,000). However, Greater Minnesota experienced the greatest increase in chlamydia cases between 2012 and 2013 (7%); followed by St. Paul (5%), Minneapolis (1%), and the Suburban area (seven-county metro excluding the cities of Minneapolis and St. Paul) experienced a decrease of 2%. Racial disparities in chlamydia continue to persist in Minnesota with the incidence rate among Blacks being 10 times that among Whites. Other racial/ethnic groups are disproportionately affected by chlamydia; incidence rates among American Indians, Asian/Pacific Islanders and Hispanics were 4.4, 1.8, and 2.4 times higher than the rate among Whites, respectively.

Gonorrhea:

In 2013, Minnesota experienced another increase (26%) in the rate of reported gonorrhea, after rates increased in 2011 for the first time since 2007. From 2003 to 2013, the incidence of gonorrhea in Minnesota increased from 64 to 73 per 100,000 persons (14%). However, as with chlamydia, the incidence of infection was higher among some segments of the population compared to others. Rates during the past decade have increased by 23% among males and 7% among females. The rates decreased among Hispanics and Blacks (41% and 15%, respectively) while rates among Whites, American Indians, & Asian/Pacific Islanders increased or remained stable. However, during this period Blacks continued to have gonorrhea incidence rates far higher than other race groups.

In 2013 the incidence rate of gonorrhea increased by 26% from 58 to 73 per 100,000 persons. As with chlamydia, gonorrhea rates were highest among females (76 per 100,000), Blacks (611 per 100,000), and 20-24 year-olds (360 per 100,000). Adolescents and young adults continue to account for a disproportionate amount (58%) of all gonorrhea cases. The Cities of Minneapolis and Saint Paul accounted for the highest rates of infection (359 and 230 cases per 100,000 persons, respectively). The greatest increase in cases from 2012 to 2013 (28%) was seen in Minneapolis, whereas, gonorrhea cases in Greater Minnesota increased by 27%, St. Paul increased by 25%, and the Suburban area (seven-county metro excluding the cities of Minneapolis and St. Paul) increased 21%, during this same time. Compared to chlamydia, greater racial disparities in gonorrhea infections continue to persist in Minnesota with an incidence rate among Blacks being 26.5 times that among Whites. These racial disparities are also evident among American Indians and Hispanics, whose rates are 7.0 and 2.3 times those of Whites.

The emergence of quinolone-resistantNeisseria Gonorrhea (QRNG) in recent years has become a particular concern. Due to the high prevalence of QRNG in Minnesota as well as nationwide, quinolones are no longer recommended for the treatment of gonococcal infections. Additionally, the CDC changed the treatment guidelines for gonococcal infections in August of 2012. CDC no longer recommends cefixime at any dose as a first-line regimen for treatment of gonococcal infections. If cefixime is used as an alternative agent, then the patient should return in one week for a test-of-cure at the site of infection.

Syphilis:

Incidence rates of primary/secondary syphilis in Minnesota remained stable from 1998 until 2002 when an outbreak was observed among men who have sex with men (MSM) and the overall rate increased from 0.2 to 1.2 per 100,000 persons. Since 2002, primary/secondary syphilis rates have fluctuated but remained elevated. In addition, the number of early syphilis cases (primary, secondary, and early latent stages) increased from 94 in 2003 to 332 in 2013, with MSM accounting for 88% of all cases among males in 2013. The disparity in early syphilis rates between males and females has remained large and reflects the greater burden within the MSM community; however the rates among females continue to increase.

In 2013, the overall incidence rate of primary/secondary syphilis increased from 2.2 to 3.6 cases per 100,000 persons. The number of cases among males increased from 111 in 2012 to 178 in 2013 while among females, the number increased from 7 to 12. Increases in cases were observed across all geographic areas; however the City of Minneapolis remains to account for the majority of cases (52%). The incidence of primary/secondary syphilis infection increased in every age group, except among persons 15-19 years of age. Whites comprised the majority (62%) of cases in 2013, while Asian/Pacific Islanders saw an increase of primary/secondary syphilis rates of 620% from 2012 to 2013. Also, Blacks comprised compromised 27% of all primary/secondary syphilis cases in 2013 and have a rate of primary/secondary syphilis that is over 7 times higher than that among Whites.

The number of early syphilis cases increased in 2013 (332 versus 214 in 2012). The number of cases among women increased from 18 cases in 2012 to 30 cases in 2013. Early syphilis cases among men increased from 196 to 298 (52%). Of all early syphilis cases reported in 2013, 90% were among males and 88% of these were MSM. Of the MSM early syphilis cases 46% were co-infected with HIV.

Chancroid:

Chancroid remains extremely rare in Minnesota. The last case reported in Minnesota was in 1999.

Summary Points:

Over the past decade (2003-2013), Minnesota’s chlamydia rates showed an overall increase of 65% while the rate of gonorrhea has fluctuated but has overall shown an increase of 14%. Rates of primary/secondary syphilis have increased 260%.

Minnesota has seen a resurgence in syphilis since 2002, with men who have sex with men being especially impacted. The co-infection rate with HIV continues to remain high.

Racial disparities in STDs continue to persist in Minnesota with communities of color having the highest rates.

Between 2012 and 2013, the chlamydia incidence rate increased by 4%, while the gonorrhea rate increased by 26%. Cases of primary/secondary syphilis increased by 64%. The greatest growth was seen among late latent syphilis cases, which increased by 71%.

In 2013, incidence rates of chlamydia increased by 7% among males and 3% among females; gonorrhea increased by 23% among males and 7% among females.

STD rates continued to be highest in the City of Minneapolis. However, the Twin Cities suburbs and Greater Minnesota accounted for a large percentage of STD cases.

Adolescents and young adults (ages 15-24) accounted for 68% of chlamydia and 58% of gonorrhea cases reported in 2013.

In 2013, men who have sex with men account for 88% of all male early syphilis cases, and rates of primary/secondary syphilis increased 620% among Asian/Pacific Islanders.

NOTE: Data exclude cases diagnosed in federal or private correctional facilities;
U.S. Census Intercensal and U.S. 2010 data is used to calculate rates.(1) Includes unstaged neurosyphilis, latent syphilis of unknown duration, and late syphilis with clinical manifestations.(2) Congenital syphilis rate per 100,000 live births.

NOTE: Data exclude cases diagnosed
in federal or private correctional facilities;
U.S. Census 2010 data is used to calculate rates.(1) Residence missing for 1,422 cases of chlamydia.(2) Suburban is defined as the seven-county metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington Counties, excluding the cities of Minneapolis and St. Paul)(3) Includes persons reported with more than one race.(4) No comparable population data available to calculate rates.(5) Persons of Hispanic origin may be of any race.. (6) Total includes 1 case of chlamydia diagnosed in transgendered persons(male to female)

NOTE: Data exclude cases diagnosed
in federal or private correctional facilities;
U.S. Census 2010 data is used to calculate rates.(1) Total includes 1 case of gonorrhea diagnosed in transgendered persons (male to female).(2) Residence missing for 194 cases of gonorrhea.(3) Suburban is defined as the seven-county metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington Counties, excluding the cities of Minneapolis and St. Paul).(4) Includes persons reported with more than one race.(5) No comparable population data available to calculate rates.(6) Persons of Hispanic origin may be of any race.

NOTE: Data exclude cases diagnosed
in federal or private correctional facilities;
U.S. Census 2010 data is used to calculate rates.(1) Suburban is defined as the seven-county metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington Counties, excluding the cities of Minneapolis and St. Paul).(2) Includes persons reported with more than one race.(3) No comparable population data available to calculate rates.(4) Persons of Hispanic origin may be of any race.(5) Total includes 3 cases of primary/secondary syphilis diagnosed in transgendered persons (male to female).

Table
3. Number of Chlamydia and Gonorrhea Cases and Rates (1) (per
100,000 persons) by County of Residence
-- Minnesota, 2013

Chlamydia

Gonorrhea

Chlamydia

Gonorrhea

County

Cases

Rate

Cases

Rate

County

Cases

Rate

Cases

Rate

Aitkin

17

105

2

-

Marshall

12

127

0

-

Anoka

884

267

157

47

Martin

50

240

2

-

Becker

74

228

4

-

Meeker

28

120

4

-

Beltrami

210

473

23

52

Mille Lacs

70

268

2

-

Benton

101

263

21

55

Morrison

69

208

9

27

Big Stone

11

209

1

-

Mower

140

357

21

54

Blue Earth

303

473

16

25

Murray

5

57

0

-

Brown

22

85

1

-

Nicollet

51

156

2

-

Carlton

102

288

8

23

Nobles

50

234

3

-

Carver

130

143

10

11

Norman

12

175

1

-

Cass

83

291

10

35

Olmsted

501

347

44

31

Chippewa

13

104

1

-

Otter Tail

78

136

8

14

Chisago

87

161

3

-

Pennington

30

215

4

-

Clay

177

300

37

63

Pine

74

249

7

24

Clearwater

20

230

2

-

Pipestone

11

115

1

-

Cook

7

135

0

-

Polk

58

184

22

70

Cottonwood

12

103

1

-

Pope

16

146

2

-

Crow Wing

137

219

8

13

Ramsey

2786

548

732

144

Dakota

1005

252

144

36

Red Lake

19

465

3

-

Dodge

55

274

4

-

Redwood

25

156

0

-

Douglas

46

128

0

-

Renville

24

153

1

-

Faribault

25

172

4

-

Rice

130

203

10

16

Fillmore

38

182

3

-

Rock

16

165

2

-

Freeborn

113

362

10

32

Roseau

37

237

2

-

Goodhue

136

294

10

22

St. Louis

729

364

88

44

Grant

10

166

1

-

Scott

269

207

25

19

Hennepin

5765

500

1983

172

Sherburne

213

241

26

29

Houston

24

126

1

-

Sibley

16

105

1

-

Hubbard

22

108

0

-

Stearns

448

297

38

25

Isanti

63

167

7

19

Steele

94

257

7

19

Itasca

100

222

12

27

Stevens

5

51

1

-

Jackson

20

195

1

-

Swift

5

51

1

-

Kanabec

25

154

1

-

Todd

36

145

1

-

Kandiyohi

136

322

6

14

Traverse

3

-

1

-

Kittson

8

176

0

-

Wabasha

39

180

0

-

Koochiching

21

158

0

-

Wadena

19

137

0

-

Lac qui Parle

5

69

0

-

Waseca

45

235

4

-

Lake

16

147

0

-

Washington

456

191

56

24

Lake of the Woods

8

198

0

-

Watonwan

30

268

2

-

Le Sueur

47

170

5

18

Wilkin

7

106

0

-

Lincoln

6

102

3

-

Winona

185

359

7

14

Lyon

51

197

2

-

Wright

197

158

25

20

McLeod

60

164

4

-

Yellow Medicine

9

86

2

-

Mahnomen

15

277

2

-

NOTE: Data exclude cases diagnosed in federal or private correctional facilities.
County data missing for 1425 chlamydia cases and 197 gonorrhea cases.
(1) Rates not calculated for counties with fewer than 5 cases.
U.S. Census 2010 data is used to calculate rates.

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